Article Detail - JF Part B

Each year from mid-November through December 31, physicians and suppliers can decide if they want to participate in Medicare for the upcoming year. Medicare "participation" means you agree to accept assignment on all claims for all Medicare-covered services furnished to your patients. By accepting assignment, you agree to accept Medicare-allowed amounts as payment in full. You may not collect more from the patient than the applicable Medicare deductible and coinsurance or copayment.

Participating Physician or Supplier

• Medicare pays the full Medicare Physician Fee Schedule allowed amount
• Medicare pays you directly
• Medicare forwards claim information to Medigap (Medicare supplement coverage) insurance

Non-Participating Physician or Supplier

• Medicare pays 5% less than the Medicare Physician Fee Schedule allowed amount
• You can't charge the patient more than the limiting charge, 115% of the Medicare Physician Fee Schedule amount for non-participating suppliers
• You may accept assignment on a case-by-case basis
• You have limited appeal rights

Required Actions

• Currently Participating and Continuing Next Year: No action is required.
• Not Participating but Wish to Participate Next Year: Complete the Medicare Participating Physician or Supplier Agreement (CMS-460) and mail it to the appropriate address for your state. The agreement must be postmarked no later than December 31, 2025.
• New Provider Enrollment: Submit the Medicare Participating Physician or Supplier Agreement (CMS-460) electronically along with your enrollment application.
• Currently Participating but Declining for Next Year: Send written notice to Noridian indicating your intent to terminate participation effective January 1 and mail it to the appropriate address for your state. The notice must be postmarked no later than December 31, 2025.
• Not Participating and Continuing Non-Participation: No action is required.